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PubMed2026

What do we know about medical invalidation and related concepts? - A scoping review and thematic analysis about the definitions, measurements, causes, consequences and potential solutions for medical invalidation.

BACKGROUND: Medical invalidation, medical gaslighting, and related constructs have gained visibility in public discourse but remain inconsistently defined in scientific literature. Despite growing research-often focused on specific diseases- to date, no single review has comprehensively synthesized their definitions, causes, consequences, or methods of measurement. This scoping review addresses this gap by examining medical invalidation and related constructs. METHODS: Using a preregistered protocol, we systematically searched PubMed, CINAHL, Web of Science, Google Scholar, and ProQuest (dissertations) without year restrictions. Eligible sources included peer-reviewed empirical, theoretical, and conceptual work in English addressing invalidation, gaslighting, or closely related notions within healthcare. A total of 158 studies were identified through database searches and citation tracking. Data extraction followed a standardized schema, and findings were synthesized descriptively and through thematic analysis to clarify terminology, map determinants and outcomes, and identify existing measurement approaches. RESULTS: The results showed substantial inconsistency in how "invalidation," "not being taken seriously," and "gaslighting" were defined. Medical invalidation emerged as a multifactorial phenomenon driven by diagnostic challenges, structural and societal factors, provider and patient characteristics, stigma, misattribution, interactional dynamics, academic knowledge gaps, and disease-related complexity. Invalidation was associated with wide-ranging behavioural, emotional, cognitive, physical, relational, and systemic harms, while validation had consistently beneficial effects. Proposed solutions in the summarized studies included communication improvements, clinician training, patient support, targeted research, and structural and systemic changes. DISCUSSIONS: Medical invalidation represents a complex, systemic issue with significant implications for patient safety. The discussion highlights its multifactorial origins, its potential to cause both psychological and physical harm, and the need for clearer conceptualisation within the field. Advancing research requires validated instruments and longitudinal designs to examine underlying mechanisms and consequences. Addressing medical invalidation will demand multi-level interventions to improve communication, reduce structural barriers, and promote equitable, patient-centred care. OSF PREREGISTRATION: https://doi.org/10.17605/OSF.IO/MPE6U.

Humans↗

PubMed2026

Remission status in persistent depressive disorder following acute treatment with psychotherapy plus medication or medication alone: A 2-year naturalistic follow-up.

OBJECTIVE: Long-term benefits of acute-phase treatments for persistent depressive disorder (PDD) are unclear. Treatment guidelines disagree on the efficacy of cognitive behavioral analysis system of psychotherapy (CBASP). We examined whether acute CBASP protected against recurrence in PDD patients over two years of naturalistic follow-up. METHODS: An observational study evaluated major depressive episode (MDE) recurrences in patients completing the Research Evaluating the Value of Augmenting Medication with Psychotherapy (REVAMP) trial. Enrollees 18-75 years had PDD: current chronic MDE, recurrent MDEs with incomplete recovery, or double depression. All received open-label antidepressant medication (ADM) for 12 weeks. Non-remitters, continuing on ADM, were randomized (2:2:1) to 12 weeks of 1) CBASP, 2) brief supportive therapy (BSP), or 3) ADM alone (MEDS). Patients completing this 12-week randomized phase were offered two-year follow-up. Blinded raters assessed the primary outcome, remission status, using the Longitudinal Interval Follow-up Evaluation and Hamilton Depression Rating Scale at 3-month intervals. Analyses evaluated group differences and non-specific predictors of remission status. RESULTS: Of 323 participants entering follow-up, 203 (62.8%) met current MDE criteria during follow-up, without between-group differences: BSP: 83 (65.3%), CBASP: 85 (60.2%), MEDS: 35 (63.6%), Chi-square = 0.75; p = 0.69. Remission after acute treatment, lack of comorbid anxiety disorder, and female gender were significantly associated with lower recurrence risk. CONCLUSION: Similar to the acute phase outcomes, no group differences emerged over the 2-year follow-up, suggesting no long-term benefit of a 12-week CBASP treatment with ADM over other PDD treatments. Findings underscore the difficulty of PDD treatment and the importance of acute treatment remission. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00057551.

Antidepressant↗

PubMed2026

Medication safety in older adults in India: an integrative PhD synthesis of direct evidence and contextual implementation evidence.

BACKGROUND: Unsafe medication practices among older adults are an important global health concern, particularly in low- and middle-income countries where multimorbidity, fragmented care, self-medication, and informal healthcare provision intersect. OBJECTIVE(S): To synthesize direct evidence on medication safety among older adults in India and contextual evidence on deprescribing and community-level provider interventions relevant to safer medication use. METHODS: This PhD synthesis integrates four studies: a record-based cross-sectional study on polypharmacy and cardiovascular autonomic function in Kolkata; a six-city community study of 600 Indian older adults; a systematic review and meta-analysis on deprescribing preventive medications in frail or end-of-life older adults; and a systematic review of informal healthcare provider interventions in low- and middle-income countries. Studies I-II provided direct Indian older-adult evidence, while Studies III-IV provided indirect contextual evidence for their optimization and implementation. RESULTS: Polypharmacy was associated with higher anticholinergic burden and numerically higher cardiac autonomic neuropathy although residual confounding limits causal interpretation. In the multicity study, one-third had polypharmacy, while potentially inappropriate medications, prescribing omissions, and self-medication were common. Risks were higher with multimorbidity, recent hospitalization, care transitions, or living alone. Deprescribing showed no statistically significant increase in mortality, hospitalization, or major cardiovascular events, but heterogeneity was high and certainty low to very low. Informal-provider interventions showed the potential to improve knowledge, referral, case management, and medication-related practices. CONCLUSIONS: Medication safety among older adults in India requires an integrated continuum approach, but direct evidence supports only some components and implementation strategies that need prospective evaluation.

Humans↗

PubMed2026

The use of 3-dimensional (3D) printing in teaching musculoskeletal oncology for medical undergraduates.

INTRODUCTION: The approach to integrating relevant anatomy in the medical curriculum has been debated for many years. Current literature has explored the broad impact of 3D printing in medical education. However, there is little evidence on 3D printing for the teaching of musculoskeletal oncology (MSO). This is a self-controlled case series (SCCS) study that aims to analyse the effectiveness of 3D printed models in MSO in enhancing the learning experience, engagement and understanding of clinical and surgical anatomy for medical students. METHOD: A cross-sectional cohort study involving 75 clinical year medical students across 3 years from 2 medical schools that rotated through a single teaching hospital's orthopaedic department. Participants first viewed a set of computed-tomography (CT) images of a large pelvic osteosarcoma from a free open-source database, the Cancer Genome Atlas Sarcoma Collection (TCGA-SARC). A standardised 10-minute pre-intervention questionnaire which comprised 15 questions categorised by: 4 questions in 'anatomical knowledge', 7 questions in 'spatial awareness', 4 questions in 'surgical planning and complications', was administered to assess the baseline knowledge in their interpretation of the pathology via CT images only. Next, a 3D-printed model of the pelvic osteosarcoma, which included colour-coded adjacent structures, was provided as an adjunct to answer the same questionnaire. This concluded with a 5-point Likert scale feedback survey to gauge their perspectives and experience. RESULTS: The mean scores comparing their pre- and post-intervention assessment questionnaire increased by +1.34 from 8.15 (SD = 1.85) to 9.49 (SD = 1.7) (p < 0.001). The final year students had the greatest improvement of +1.54 from 8.00 (SD = 1.89) to 9.54 (SD = 1.59) (p = 0.004). There was no significant difference between the scores amongst the 2 medical schools. 91% of students agreed that the 3D model had helped them further their understanding of the anatomy of the sarcoma and 87% would want 3D printing models to augment their learning in anatomy. Baseline weaker students demonstrated significantly greater improvement in scores compared with baseline stronger students (mean difference +2.04 vs +0.30, p < 0.001). CONCLUSION: 3D printing is an effective teaching adjunct for musculoskeletal oncology surgical anatomy for medical undergraduates and could be used to enhance their understanding and learning experience. 3D models could be integrated in the teaching curriculum of surgical anatomy for undergraduate students.

Humans↗

PubMed2025

Reconciling competencies in undergraduate medical genetics education: APHMG versus PCME competencies.

PURPOSE: We wanted to understand whether there were gaps within and/or between the Association of Professors of Human and Medical Genetics (APHMG) and the Association of Pathology Chairs (APC) published competencies for undergraduate medical education pertaining to topics in medical and/or laboratory genetics. METHODS: This study compared and contrasted the APHMG and APC competencies related to genetics to identify gaps between and within each to inform the closure of those gaps in undergraduate medical education curriculum development for medical and laboratory genetics at the University of Florida. RESULTS: Gaps were identified within and between both documents, many relating to neoplasia for nonheritable cancers and various topics related to laboratory genetics, such as interpretation of results, principles of laboratory diagnostics, and explaining results to others. CONCLUSION: APHMG and APC should consider the gaps identified in this study in future updates to their respective competencies. Additionally, medical school curriculum committees may also wish to consider addressing these gaps in the development of medical genetics curricula.

Humans↗

PubMed2026

Psychiatric and neurological predictors of early ADHD medication discontinuation across the lifespan: a multinational study.

BACKGROUND: Early discontinuation of attention-deficit/hyperactivity disorder (ADHD) medication is common and linked to worse outcomes. Identifying clinical predictors could aid personalised treatment yet evidence is inconsistent across ages and countries/regions. OBJECTIVE: Investigate psychiatric and neurological comorbidity as predictors of early ADHD medication discontinuation in new ADHD medication users across age groups, sex and countries/regions. METHODS: Using health records from eight countries/regions, we identified 1 000 411 (44% female) new ADHD medication users (2011-2020). Discontinuation was defined as a ≥180 day gap between dispensations. We examined 23 indicators of psychiatric or neurological comorbidity, severity and psychotropic medication use. Associations were estimated using Cox regression, pooled with random-effects meta-analyses and stratified by age-at-initiation and sex. FINDINGS: Discontinuation rates varied widely (children 19%-61%, adolescents 37%-68%, young adults 52-67%, adults 38%-68%). In pooled analyses, earlier discontinuation in children was predicted by intellectual disability, autism and use of psychotropic medications (HR range 1.32-1.51), while conduct/oppositional defiant disorder (CD/ODD) was protective (HR 0.83, 95% CI 0.73 to 0.94). In adolescents, no indicators remained statistically significant after multiple-testing control. In young adults, CD/ODD (HR 1.42, 95% CI 1.30 to 1.55), and in adults, schizophrenia (HR 1.25, 95% CI 1.09 to 1.44) and tic disorders (HR 1.27, 95% CI 1.11 to 1.46) predicted earlier discontinuation. Statistical heterogeneity was substantial, largely driven by US estimates. In meta-analyses excluding the USA, additional associations emerged. For example, in children, OCD and anxiety disorders predicted earlier discontinuation, while eating disorders and antidepressants/anxiolytics were protective in adults. Associations with schizophrenia, tic disorders and CD/ODD were no longer significant. Country-specific analyses showed similar association patterns, except in the USA, Hong Kong and the UK. Sex differences were limited. CONCLUSIONS: Children with neuropsychiatric comorbidity and related comedication are more likely to discontinue ADHD medication early, whereas few consistent predictors were seen from adolescence onwards. Marked cross-country variation, particularly in the USA, points to system-level influences on treatment patterns. CLINICAL IMPLICATIONS: Improving ADHD medication persistence will require consideration of healthcare context and age-specific strategies, including close monitoring for children with complex neuropsychiatric profiles, and consideration of broader factors in adolescents and adults, where clinical predictors were limited.

Humans↗

PubMed2026

The influence of organizational culture on medication safety practices and associated risk factors in the community setting: A systematic review.

BACKGROUND: Increasing attention has been given to the role of organizational culture in influencing medication safety practices across healthcare settings. The lack of widely accepted standardized instrumentation makes operational measurement of organizational culture and medication safety challenging. The purpose of this systematic review was to examine the impact of organizational culture on medication safety within community healthcare settings. METHODS: MEDLINE, CINAHL, Scopus, and Nursing & Allied Health were searched in August 2025 using keywords, subject terms, field codes, and Boolean operators to identify papers relevant to the review question; bibliographies of included studies were also reviewed. Screening and full-text review were completed independently by two reviewers with a third to adjudicate conflicts. The Critical Appraisal Skills Programme was used for quality assessment. The PRISMA statement guided the development and implementation of the review. RESULTS: Thirteen articles were included representing various community settings. Most studies reported on untoward medication events, but few measured systematically collected safety data before and after an intervention. Organizational culture was seldom defined or operationalized. Most studies were methodologically sound, but the overall level of evidence was weak to moderate. CONCLUSION: Organizational culture influences medication safety through aspects such as communication channels, teamwork, training, and an environment that allows error and near-miss reporting. Few studies explicitly evaluate the causal impact of culture interventions on measurable medication safety outcomes in community healthcare settings. Further research should incorporate standardized measurement tools and intervention-based, pre-post designs to better understand how organizational culture influences medication safety in community healthcare settings.

Organizational Culture↗

PubMed2025

Covering medical care costs for participants in the eMERGE Network: Challenges for equity and implementation.

PURPOSE: To investigate the complexities of covering study-recommended medical care costs for individuals (in order to prevent lack of adherence due to financial reasons), which have received little attention. METHODS: We explored the deliberations, decisions, and challenges faced by the Electronic Medical Records and Genomics (eMERGE) Network during the implementation of a genomic research project recommending clinical care based on high-risk results defined largely by polygenic risk scores. Two surveys were disseminated to eMERGE sites: to identify preferences about payment for specific care recommendations (survey 1) and to understand the operational processes of covering medical care costs (survey 2). RESULTS: Paying for a subset of care recommendations for the funded study duration was identified as the most feasible approach for covering medical care costs for participants who received high-risk genomic results. Each eMERGE site, by necessity, used diverse approaches to pay for medical care costs. CONCLUSION: eMERGE researchers balanced competing concerns about bias, equity, study design, regulatory compliance, and cost in designing a unified approach to cover some of the recommended medical care costs in the study. Many implementation challenges were encountered. Findings can inform researchers and regulatory bodies about the implications and complications of covering medical care costs in translational research studies focused on prevention.

Humans↗

PubMed2026

Assessing AI literacy and attitudes among medical students: implications for integration into healthcare practice.

PURPOSE: This study aims to assess AI literacy and attitudes among medical students and explore their implications for integrating AI into healthcare practice. DESIGN/METHODOLOGY/APPROACH: A quantitative research design was employed to comprehensively evaluate AI literacy and attitudes among 374 Lusaka Apex Medical University medical students. Data were collected from April 3, 2024, to April 30, 2024, using a closed-ended questionnaire. The questionnaire covered various aspects of AI literacy, perceived benefits of AI in healthcare, strategies for staying informed about AI, relevant AI applications for future practice, concerns related to AI algorithm training and AI-based chatbots in healthcare. FINDINGS: The study revealed varying levels of AI literacy among medical students with a basic understanding of AI principles. Perceptions regarding AI's role in healthcare varied, with recognition of key benefits such as improved diagnosis accuracy and enhanced treatment planning. Students relied predominantly on online resources to stay informed about AI. Concerns included bias reinforcement, data privacy and over-reliance on technology. ORIGINALITY/VALUE: This study contributes original insights into medical students' AI literacy and attitudes, highlighting the need for targeted educational interventions and ethical considerations in AI integration within medical education and practice.

Students, Medical↗

PubMed2026

The impact of pharmacogenetic-informed care on medication adherence and psychological factors associated with adherence: A narrative review.

Improvement in medication adherence is often proposed as a potential advantage of pharmacogenetic-guided prescribing over a traditional one-size-fits-all approach. This paper provides a review of the published literature and presents the findings of studies that measure adherence to medication as an outcome of pharmacogenetic-informed care, or that measure the impact of pharmacogenetic-informed care on psychological factors that are associated with medication adherence. Adherence-related psychological factors are mapped to the Theoretical Domains Framework (TDF) to provide insight into how participants interact with pharmacogenetic-informed care as an intervention and to consider this in the context of medication adherence. A total of 23 studies were included, with 10 quantitative studies measuring medication adherence outcomes associated with pharmacogenetic-informed care. Five of these studies found a statistically significant improvement in adherence in the pharmacogenetic-tested group, two reported a small but non-significant trend, and three showed no difference. Additionally, 13 studies examined the impact of pharmacogenetic-informed care on psychological factors related to adherence. These factors were mapped to 10 TDF domains: knowledge (8 studies); social/professional role and identity (1); beliefs about capabilities (2); optimism (4); beliefs about consequences (10); intentions (5); goals (1); memory, attention and decision processes (7); social influences (4); and emotion (8). The findings suggest that although the evidence for pharmacogenetic-informed care improving medication adherence is mixed and limited, pharmacogenetic-informed care appears to positively influence psychological factors that may support adherence. These include improving knowledge, supporting decision-making and generally being perceived as a positive experience by patients.

adherence↗

PubMed2026

Psychiatric Diagnoses and Psychotropic Medications Among Military-Affiliated Adolescents and Young Adults With Polycystic Ovary Syndrome.

PURPOSE: To study rates of psychiatric diagnoses and psychotropic medication prescription among U.S. military-affiliated adolescents and young adults (AYA) with polycystic ovary syndrome (PCOS). METHODS: This retrospective matched cohort study included U.S. military-affiliated AYA (aged 15-21 years) enrolled in TRICARE Prime for at least 6 months during the surveillance period (January 2016 to October 2023). Military-affiliated AYA were grouped into three categories: individuals diagnosed with PCOS (N = 6,911), age-matched individuals with no diagnosed PCOS symptoms (N = 35,814), and individuals with diagnosed symptoms suggestive of PCOS (N = 2,136). The presence of a psychiatric diagnoses and prescriptions for psychotropic medications were obtained via the International Classification of Diseases, 10th Revision, Clinical Modification codes and National Drug codes, respectively. RESULTS: AYA with diagnosed PCOS had higher odds of having a psychiatric diagnosis and being prescribed a psychotropic medication compared to an age-matched comparison group (psychiatric diagnosis odds ratio [OR] = 2.48 [2.35-2.62], medication OR = 2.14 [2.03-2.25]) and individuals with symptoms suggestive of PCOS (psychiatric diagnosis OR = 1.11 [1.003-1.23], medication OR = 1.16 [1.05-1.28]). DISCUSSION: The odds of psychiatric comorbidities and psychotropic medication prescription were more than twice as high as among U.S. military-affiliated AYA with PCOS. More research is needed to determine whether health-care utilization and military-related factors impact mental health outcomes among AYA with PCOS. Additionally, tailored, multidisciplinary mental health services for AYA with PCOS are needed.

Humans↗

PubMed2026

Antibiotic Self-Medication and Public Awareness During the 2023 Gaza War: A Cross-Sectional Investigation.

BACKGROUND: Antimicrobial resistance is driven by inappropriate antibiotic use, particularly self-medication. The 2023 Gaza War disrupted healthcare services, increasing resistant infections and reliance on self-treatment practices. OBJECTIVES: To determine the prevalence of antibiotic self-medication and assess public awareness during the 2023 Gaza War. METHODS: A cross-sectional survey was conducted between May and October 2025 among adults residing in the Gaza Strip during the 2023 Gaza War. A multistage non-probability recruitment strategy, organized across predefined governorate and residential-setting strata, was used to recruit 422 participants from primary healthcare centers, community pharmacies, and displacement shelters. The questionnaire demonstrated good internal consistency (Cronbach's α = 0.857). Ethical approval was obtained from the relevant institutional review board, and informed consent was secured from all participants. RESULTS: The overall KAP score was moderate (67.46%), with attitudes scoring highest (74.62%), followed by knowledge (66.23%) and practices (61.52%). Reported antibiotic self-medication increased from 60.4% before the war to 80.6% during the war (p < 0.001), with significant changes in reasons for self-medication and antibiotic procurement sources. The mean antimicrobial-resistance perception score was 82.19 ± 11.10%, and knowledge was strongly correlated with the total KAP score (r = 0.836, p < 0.001). CONCLUSIONS: Reported antibiotic self-medication was markedly higher during the 2023 Gaza War despite moderate public awareness, highlighting the urgent need for education, antibiotic stewardship, and improved healthcare accessibility.

Gaza War 2023↗

PubMed2025

Shared genetic risk and causal associations between Post-traumatic stress disorder and migraine with antithrombotic agents and other medications.

Post-traumatic stress disorder (PTSD) is a psychiatric disorder that frequently co-occurs with pain disorders including migraine. There are proposed biological, genetic and environmental factors associated with both PTSD and migraine suggesting shared etiology. Genome-Wide Association Studies (GWAS) have been used to identify genomic risk loci associated with various disorders and to investigate genetic overlap between traits. There is a significant genetic correlation between PTSD and migraine with no evidence of a causal relationship that could be attributed to pleiotropy. Cross-disorder genetic analyses were applied to investigate the genetic overlap and causal associations using GWAS summary statistics of PTSD (n = 214408), migraine (n = 873341) and 23 medication use traits (n = 78808-305913) including anti-depressants, anti-migraine preparations and beta-blocking agents. Across the entire genome, anti-thrombotic agents had a significant and negative genetic correlation with PTSD (rG = -0.2, P FDR = 0.032) and a positive genetic correlation with migraine (rG = 0.26, P FDR = 2.23 x 10-8). PTSD showed significant genetic correlation with 11 other medication use traits including beta blocking agents (rG = -0.11, P FDR = 0.034). Of the 2495 genomic regions tested, PTSD showed significant local genetic correlation with 12 medication use traits at 43 loci; while migraine showed significant genetic correlation with only anti-inflammatory agents and anti-rheumatic products at locus 12:57522282-57607142 (DAB1) (P < 2 x 10-5). The genetic liability to PTSD had a causal effect on increased risk of using pain medication such as opioids (β ivw = 0.59, P = 5.21 x 10-5) while the genetic liability to migraine had a causal effect on the increased risk of using anti-thrombotic agents (β ivw = 0.59, P = 1.69 x 10-7). The genes in the genomic regions shared between PTSD and medication use traits were enriched in neural-related pathways such as neuron development, neurogenesis and protein kinase activity. These results provide further insight into the genetically controlled biological and environmental factors underlying the shared etiology between PTSD and migraine. The identified biomarkers can be used as a basis for investigation as potential drug targets for both disorders. These findings are significant for drug re-purposing and treatment of PTSD and migraine using monotherapy.

GWAS↗

PubMed2025

The 2023 medical genetics workforce in the United States.

PURPOSE: To characterize the 2023 medical genetics and genomics workforce in the United States-comprising clinical geneticists, genetic counselors, genetic nurses, genetic physician assistants, laboratory geneticists, and metabolic dietitians-to inform genetics workforce efforts. METHODS: National genetics membership or board-certification organizations distributed an electronic survey to medical genetics professionals in early 2023. Questions were derived from prior workforce surveys and by a workgroup led by the National Coordinating Center for the Regional Genetics Networks. RESULTS: Of the 3070 medical genetics professionals who responded, 66.0% were genetic counselors, 15.4% were clinical geneticists, 12.2% were laboratory geneticists, 4.7% were metabolic dietitians, and 1.7% were genetic nurses or physician assistants. The respondents identified as White (76.1%) and women (84.7%); there were statistically significant differences between disciplines. Forty percent worked in academic centers; 55.3% worked 41+ hours per week. Nearly 11% of respondents provided services in a language other than English. Despite 34.7% of respondents experiencing some burnout, most had no plans to leave the field (94.4%) within the next year. CONCLUSION: The medical genetics community needs to advance workforce initiatives to support current personnel and attract new and diverse individuals to the field to serve patients and their families.

Humans↗

PubMed2026

Educational interventions to improve medical students' bad news communication skills: A systematic review and meta-analysis.

OBJECTIVES: This systematic review aimed to both determine whether educational interventions improve medical students' ability and/or confidence in Bad News Communication (BNC), as well as assess the relative efficacy of instructional formats. METHODS: Performed according to the PRISMA guidelines, four databases were searched for articles describing education-based interventions to improve medical student's BNC ability and/or confidence, published in English between 2001 and 2024. Data on students' self-reported or observer-assessed level of competence/ability in BNC (primary outcome), and students' self-assessed confidence in BNC skills (secondary outcomes), were analysed. Meta regression explained the influence of several categorical moderators on heterogeneity in relation to intervention effects on competence/ability. RESULTS: 27 studies met the criteria for inclusion in the systematic review and 17 studies for the meta-analysis. Interventions described in controlled studies were associated with a moderate and significant increase in BNC ability (13 data sets; standardized mean difference [SMD] = 1.09, 95% CI = 0.52 - 1.66). Interventions detailed in pre-post design studies were associated with a significant increase in BNC ability (20 data sets; SMD = 0.92, 95% CI = 0.52 - 1.32), and student confidence/comfort in their BNC skills (12 data sets; SMD = 1.16, 95% CI = 0.57 - 1.75). Subgroup analysis demonstrated better skills/competence outcomes in studies that included simulation-based training (SBT). CONCLUSIONS: Educational interventions improve the BNC ability and confidence of medical students. Interventions should include an SBT element as this leads to greater improvements in BNC ability. Further research is needed to determine to what extent these interventions translate to positive patient outcomes. PRACTICE IMPLICATIONS: Diverse educational programme, especially those including simulation-based training, are effective in improving BNC skills, although the longetivity of these improvements is at present unclear. Therefore, we recommend that refresher courses or practice opportunities should be scheduled throughout students' medical education to ensure retention of BNC skills.

Humans↗

PubMed2026

Effect of Peer Comparison Feedback and Professional Norms on Vitamin D Testing and Generic Medication Prescribing.

BACKGROUND: Organization for Economic Cooperation and Development (OECD) estimates suggest that 20% of health care spending is wasteful or even harmful. Previous interventions have had limited success in discouraging low-value care in medical practice. METHODS: We conducted a nationwide randomized controlled trial among primary care physicians (PCPs) in Switzerland (November 2020-December 2021). We randomly assigned PCPs to one of three intervention groups related to low-value care (vitamin D testing, generic prescribing, or a cost intervention) or a control group. This article reports results for the vitamin D testing and generic prescribing interventions compared with the common control group. PCPs in the intervention groups received a personalized information letter combining professional norms and peer comparison feedback about the low-value service (either vitamin D testing or prescribing of nongeneric medications). Primary endpoints were (1) the number of vitamin D tests per 100 patients and (2) the share of generic medications prescribed. We estimated average treatment effects using linear regression and assessed effect heterogeneity with a causal forest. RESULTS: A total of 618 PCPs were randomly assigned to the vitamin D intervention, 597 to the generic prescribing intervention and 601 to the common control group. The intervention reduced average vitamin D testing by 3.66 tests per 100 patients (95% confidence interval [CI], -5.42 to -1.89; P<0.001). The intervention did not increase average generic medication prescribing (mean difference, +0.57 percentage points; 95% CI, -0.68 to +1.81 percentage points; P=0.37). Heterogeneity analysis suggested that reductions in vitamin D testing among physician subgroups ranged from one to seven per 100 patients and that higher baseline generic prescribing rates were associated with increases in generic substitution following the intervention. No increases in low-value care were seen among those physicians with low baseline levels. CONCLUSIONS: Peer comparison letters emphasizing professional norms reduced vitamin D testing but did not increase generic medication prescribing. (Funded by the Swiss National Science Foundation; AEA Randomized Controlled Trials Registry no., AEARCTR-0004747.).

Humans↗

PubMed2026

Medically Unexplained Symptoms: A Systematic Umbrella Review of Current Terminology and Reported Rationales.

OBJECTIVES: Toaddress current naming conventions for Medically Unexplained Symptoms (MUS) through a systematic umbrella review. The terminology used and the provided rationales were considered. METHODS: Registered with PROSPERO (CRD42024526020), this review searched 8 key databases, last on January 28, 2025. Reviews including medically unexplained symptoms (or synonym or subtype) in their systematic search terms were included (N=422). RESULTS: A total of 577 references to 111 terms were made across the reviews, with numerous reviews using the same overarching terms, including "functional" (n=233), "somatic" (or variants thereof, n=51), and "medically unexplained" (n=28). Thirty percent of terms (n=179) were to specific syndromes or terms that did not group together under an overarching term, suggesting substantial variability in terms, even though over 60% of authors were primarily associated with just 3 disciplines: medicine, allied health, and psychology. A subset of 23 reviews provided rationales, which were subjected to content analysis and a ROBIS (Risk of Bias in Systematic Reviews) risk-of-bias assessment. This analysis showed that rationales tended to (1) highlight differences between psychological, psychiatric, and other medical fields (n=7); (2) focus on the patient perspective and patient-practitioner therapeutic relationship (n=10); or (3) follow broad and/or commonly used terms (n=7). DISCUSSION: The current landscape of terminology used for MUS remains varied, nuanced, and inconsistent between disciplines. Moving forward to a more universal language accepted and used by both patients and practitioners would aid in the diagnosis, management, and treatment of MUS.

Humans↗

PubMed2025

MedImg: An Integrated Database for Public Medical Images.

The advancements in deep learning algorithms for medical image analysis have garnered significant attention in recent years. While several studies have shown promising results, with models achieving or even surpassing human performance, translating these advancements into clinical practice is still accompanied by various challenges. A primary obstacle lies in the availability of large-scale, well-characterized datasets for validating the generalization of approaches. To address this challenge, we curated a diverse collection of medical image datasets from multiple public sources, containing 105 datasets and a total of 1,995,671 images. These images span 14 modalities, including X-ray, computed tomography, magnetic resonance imaging, optical coherence tomography, ultrasound, and endoscopy, and originate from 13 organs, such as the lung, brain, eye, and heart. Subsequently, we constructed an online database, MedImg, which incorporates and systematically organizes these medical images to facilitate data accessibility. MedImg serves as an intuitive and open-access platform for facilitating research in deep learning-based medical image analysis, accessible at https://www.cuilab.cn/medimg/.

Humans↗